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Neurology：病例：搏动性突眼伴外斜性双侧核间性眼肌麻痹

2018-05-29 zxy 神经科病例撷英拾粹

搏动性突眼头部外伤梗死
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65岁有高血压病史的男性患者，表现为视物成双。查体可见外斜性双侧核间性眼肌麻痹（wall-eyed bilateral internuclear ophthalmoplegia，WEBINO）（图1）和左眼无症状性，与脉搏同步的搏动性突眼。

65岁有高血压病史的男性患者，表现为视物成双。查体可见外斜性双侧核间性眼肌麻痹（wall-eyed bilateral internuclear ophthalmoplegia，WEBINO）（图1）和左眼无症状性，与脉搏同步的搏动性突眼。据患者陈述，其在儿童时期有过头部钝性外伤史，从那时起就有眼球搏动。由于眶顶骨质缺损，CT可见脑膜膨出突入左侧眼眶（图2A）。CT血管造影排除了颈动脉海绵窦瘘。 MRI提示中脑被盖中线处急性梗死灶，累及双侧内侧纵束，导致WEBINO（图2B）。搏动性突眼是因儿童时期头部损伤引起眶顶骨折，使得脑血管的搏动通过脑脊液传到相应的脑膜膨出所致。


（图1：双眼在第一眼位可见外斜视，双侧核间性眼肌麻痹伴侧视时内收障碍；上视也轻度受累）


（图2：A：冠状位头颅CT可见左侧眶顶骨折伴脑膜膨出；B：T2W可见中脑被盖中线处急性梗死，累及双侧内侧纵束）

患者可见外斜性双侧核间性眼肌麻痹和左眼无症状性，与脉搏同步的搏动性突眼

原始出处：Papageorgiou E, Tsironi EE, Androudi S, Koltsidopoulos P.Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral internuclearophthalmoplegia.Neurology. 2018 Apr 24;90(17):e1542-e1543.

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    2018-08-27 yinhl1978

    #Neurol#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2000437, encodeId=4aad200043ed3, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Aug 27 22:30:00 CST 2018, time=2018-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522404, encodeId=36eb1522404b1, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Thu May 31 14:30:00 CST 2018, time=2018-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319861, encodeId=2ccd31986171, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed May 30 06:54:07 CST 2018, time=2018-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319838, encodeId=603131983838, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed May 30 06:09:33 CST 2018, time=2018-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319815, encodeId=432b31981534, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Wed May 30 03:35:20 CST 2018, time=2018-05-30, status=1, ipAttribution=)]
    2018-05-31 wangbingxhy

    #双侧#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2000437, encodeId=4aad200043ed3, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon Aug 27 22:30:00 CST 2018, time=2018-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522404, encodeId=36eb1522404b1, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Thu May 31 14:30:00 CST 2018, time=2018-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319861, encodeId=2ccd31986171, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed May 30 06:54:07 CST 2018, time=2018-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319838, encodeId=603131983838, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Wed May 30 06:09:33 CST 2018, time=2018-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=319815, encodeId=432b31981534, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Wed May 30 03:35:20 CST 2018, time=2018-05-30, status=1, ipAttribution=)]
    2018-05-30 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

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    2018-05-30 三生有幸9135

    学习一下谢谢分享

    0

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    2018-05-30 飛歌

    学习了很有用不错

    0